VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14.

transcript

VBID 101

Nancy R. MorrisCommunication & Member Relations Director

10-15-14

Value Based Insurance Design

A form of benefit design that promotes the use of healthcare services that provide more “value” over those services that provide less

63%25%

Preference-sensitivecare

Effective care

Supply-sensitive care

The Dartmouth Institute for Health Policy and Clinical Practice (Wennberg, Weinstein, Fisher, et al.)

Not All Services Are Created Equal

CEO Summit Recommendation

Message from CEO group:

Develop and offer a benefit plan that supports what you want us to do

• Reduce the total cost of care per person per year in Maine to the national average;

• Improve the health of Maine’s population in at least four categories of disease prevalence (including diabetes, mental health, obesity, and tobacco use);

• Improve patient experience scores for targeted practices by 2% from the baseline 2012 survey;

• Increase the number of practices reporting patient experience information from 50% to 66%

Maine’s SIM Goals

MHMC VBID Plan Design

Using EMR’s To Aid in Communication

Slow Down and Review Options

Clearing the Path to High ROI Service Use

Stop and Look at the Evidence Before Proceeding

Goal: Reduce Unnecessary Services $265 Billion IOM

Green Services

Yellow Services- SDM

Providing Cost Information Too

Red Services

Assuring High Quality Delivery

PCMH’s are the hub. When necessary they refer to:

Quality

Effective & Efficient

Ineffective &

Inefficient

Ineffective & Efficient

Effective &

Inefficient

High Low

Goal: Reduce high prices and inefficiently delivered services $155 Billion IOM

Reimbursement is Based on Attaining Outcomes

Providers/ Patients/ Health Plans and Payors share in savings produced by the reduction in preventable admissions and improved health

• ACO’s• Alternative Quality Contracts

Making the Patient Part of the Team

Employ incentives and disincentives to produce healthy lifestyle choices and support management of chronic illness at the:

• workplace • the community at large

Goal: Take advantage of missed preventive opportunities $55 Billon IOM

Administrative Simplification

•Identify areas of improvement through provider/member complaint logs and patient, provider, health plan, and advocate insights then simplify processes to reduce administration cost burden through process improvement

•Reduce across complexity through standardization across public and private payers through consistency where possible (claim billing, prior-authorization)

•Adjust plan benefits so they encourage the desired behavior in all parties

Goal: Reduce Excessive Administrative Costs $190 Billion IOM

Current Health Plan Rating Display

• Working to standardize VBID benefits

• Working to standardize provider value ratings

• Working to standardize administrative requirements

Potential Future Health Plan Rating Display

Prefers safe providers

Encourages use of shared-decision making tools

Prefers providers with best patient survey results

Does not pay for preventable complications

Why Work Together?

•The data is more robust

•We have data to serve as neutral arbitrator

•Standardization if the foundation of quality improvement

– Operating rules

– Quality measurement

• Together we are more attractive to other organizations

– EMR vendors

– Grantors

– Government payors

• We have any opportunity to attract and maintain more primary care physicians

• We are better prepared for a crisis

Community Effort

• Aetna• Cigna• Anthem• Harvard Pilgrim Health Plan• Maine Community Health

Options• Medical Mutual• Geisinger• MaineCare

Health Plans/Payers

Brokers

Providers/Associates

State & Federal

Others

Community Effort

Health Plans/Payers

Brokers

• Cross Agency• Holden Agency• USI• Aliant• Acadia Benefits

State & Federal

Others

Community Effort

Health Plans/Payers

Brokers

• HealthReach• Maine Optometric Association• MaineHealth• Maine General• OMC Wellness• St. Mary’s• Spurwink• MidCoast Health• InterMed• Maine Osteopathic Association

State & Federal

Others

Community Effort

Health Plans/Payers

Brokers

• Centers for Medicare & Medicaid Innovation

• Maine State Employee Health and Benefits Office

• Maine CDC• Veteran’s

Administration• MEABT• Maine BOI• DHHS

State & Federal

Others

Community Effort

Health Plans/Payers

Brokers

• Lown Institute-MA• IMD Foundation-MA• City of Portland• Maine Quality Counts• Maine Areas on Aging• Health Care Administrative

Solutions, Inc.-MA• Brian Atchison• Milliman MedInsight – Waste

Calculator-WA• Athena• www.TheNNT.com

State & Federal

Others

Community Effort

Health Plans/Payers

Brokers

• Robert Wood Johnson Foundation-NJ

• Oregon State-OR• Internal MHMC staff• Neel Shah, Costs of Care-MA• Integrated Health Association-

CA• Pacific Business Group on

Health-CA• AARP

State & Federal

Others

Continued

How Can You Get Involved

http://www.youtube.com/watch?v=hO8MwBZl-Vc

VBID 101 Nancy R. Morris Communication & Member Relations Director 10-15-14.

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